Evolution of ACTH dosing, largely through abstract review

Hrachovy RA, Frost JD Jr, Kellaway P, Zion T. A controlled study of ACTH therapy in infantile spasms. Epilepsia. 1980 Dec;21(6):631-6.

There appeared to be no consistent difference in serum cortisol levels between patients receiving 20 units/day of ACTH and those receiving 30 or 40 units/day, and there was no difference in cortisol levels in those patients who became hypertensive and those who did not.

Singer WD, Rabe EF, Haller JS. The effect of ACTH therapy upon infantile spasms. J Pediatr. 1980 Mar;96(3 Pt 1):485-9.

Fifty-five infants with infantile spasms and hypsarrhythmia, who were treated with ACTH using 80 units im every other day for a mean period of ten months, were studied retrospectively and showed better results than infants using so-called nonsteroidal anticonvulsants or ACTH and steroids in other doses and with other time intervals.

Lerman P, Kivity S. The efficacy of corticotropin in primary infantile spasms. J Pediatr. 1982 Aug;101(2):294-6.

(Article) Thirteen patients were considered to have received "adequate" treatment--those initially given at least 80 units of ACTH-gel daily or depot-tetracosactrin according to the protocol; 12 patients were considered to have been treated "inadequately," with lower dosages or shorter duration of treatment.

Hrachovy RA, Frost JD Jr, Kellaway P, Zion TE. Double-blind study of ACTH vs prednisone therapy in infantile spasms. J Pediatr. 1983 Oct;103(4):641-5. 

Twenty-four patients with infantile spasms were entered in a double-blind, placebo-controlled, crossover study to compare the therapeutic effectiveness of ACTH (20 to 30 units/day) with that of prednisone (2 mg/kg/day).

Snead OC 3rd, Benton JW, Myers GJ. ACTH and prednisone in childhood seizure disorders. Neurology. 1983 Aug;33(8):966-70.

The initial dose was 150 units per square meter body surface area (M2) per day in two divided intramuscular (IM) doses for 7 days. The dosage in the second week was 75 units per M2 per day in a single daily IM dose. In the third and fourth weeks, the patient received 75 units per M2 every other day in a single IM dose. During the final 8 weeks of this 12-week course, the dosage was gradually tapered.

Glaze DG, Hrachovy RA, Frost JD Jr, Kellaway P, Zion TE. Prospective study of outcome of infants with infantile spasms treated during controlled studies of ACTH and prednisone. J Pediatr. 1988 Mar;112(3):389-96.

ACTH was given at a dosage of 20 U/day for the first 2 weeks; if there Was no response, the dosage was increased to 30 U/day for 4 weeks.

Snead OC 3rd, Benton JW Jr, Hosey LC, Swann JW, Spink D, Martin D, Rej R. Treatment of infantile spasms with high-dose ACTH: efficacy and plasma levels of ACTH and cortisol. Neurology. 1989 Aug;39(8):1027-31.

Fifteen children with infantile spasms and a hypsarrhythmic EEG defined by EEG-videotelemetry monitoring received a regimen of high-dose (150 IU/m2/d) ACTH for their seizures.

(from the article) ACTH protocol. The protocol described previouslys was used in this study. Briefly, the initial dose was 75 IU/m2 intramuscularly (IM) twice daily for 1 week, then 75 IU/m2/ d for 1 week, followed by 75 IU/m2 every other day for 1 week. This was followed by a 9-week taper.